Multi-channel deep learning model-based myocardial spatial-temporal morphology feature on cardiac MRI cine images diagnoses the cause of LVH

Abstract

Background: To develop a fully automatic framework for the diagnosis of cause for left ventricular hypertrophy (LVH) via cardiac cine images.

Methods: A total of 302 LVH patients with cine MRI images were recruited as the primary cohort. Another 53 LVH patients prospectively collected or from multi-centers were used as the external test dataset. Different models based on the cardiac regions (Model 1), segmented ventricle (Model 2) and ventricle mask (Model 3) were constructed. The diagnostic performance was accessed by the confusion matrix with respect to overall accuracy. The capability of the predictive models for binary classification of cardiac amyloidosis (CA), hypertrophic cardiomyopathy (HCM) or hypertensive heart disease (HHD) were also evaluated. Additionally, the diagnostic performance of best Model was compared with that of 7 radiologists/cardiologists.

Results: Model 3 showed the best performance with an overall classification accuracy up to 77.4% in the external test datasets. On the subtasks for identifying CA, HCM or HHD only, Model 3 also achieved the best performance with AUCs yielding 0.895-0.980, 0.879-0.984 and 0.848-0.983 in the validation, internal test and external test datasets, respectively. The deep learning model showed non-inferior diagnostic capability to the cardiovascular imaging expert and outperformed other radiologists/cardiologists.

Conclusion: The combined model based on the mask of left ventricular segmented from multi-sequences cine MR images shows favorable and robust performance in diagnosing the cause of left ventricular hypertrophy, which could be served as a noninvasive tool and help clinical decision.

Keywords: Cardiac cine MRI; Case prediction; Deep learning; Left ventricular hypertrophy.

Fig. 1

Patient enrollment and study design. HCM—hypertrophic cardiomyopathy, CA—cardiac amyloidosis, HHD—hypertensive heart disease, DL—deep learning

Fig. 2

Illustration of data pretreatment for the development of Model 1, Model 2 and Model 3. ROI—region of interest

Fig. 3

Schematic of the fully automatic framework for predicting the cause of left ventricular hypertrophy through cine MR images. 2CH—two-chamber, 4CH—four-chamber, SAX—short axis

Fig. 4

Confusion matrix comparison across Model 1 (A–C), Model 2 (D–F) and Model 3 (G–I) in the validation, internal test and external test datasets, respectively. Note that all models noticeably confuse HCM and HHD in the external test dataset. HCM, hypertrophic cardiomyopathy, CA, cardiac amyloidosis, HHD, hypertensive heart disease

Fig. 5

Comparision of the confusion matrix between the senior cardiovascular imaging cardiologist (A), senior radiologist (B), junior radiologist 1 (C), junior radiologist 2 (D), senior general cardiologist (E), junior cardiologist 1 (F), junior cardiologist 2 (G) and the Model 3 (H) in the external test dataset

Fig. 6

Comparison between the deep learning model (Model 3) and radiologists/cardiologists for the binary classification of CA (A), HCM (B) or HHD (C) in the external test dataset. HCM, hypertrophic cardiomyopathy, CA, cardiac amyloidosis, HHD, hypertensive heart disease, DL, deep learning

Fig. 7

Illustrations of cine images and the corresponding ROIs in Model 3 of different LVH type